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Lessons in Customer Service

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My time working at the Apple Store formed the foundation of my professional development. I learned how to talk to customers in a mature manner and to keep my cool under pressure. I had just turned 18 when I got the job and I quickly learned that I would be interacting with highly educated and accomplished clientele that were coming into the store to spend a lot of money. During my employment, I helped physicians, businessmen/women, and even met a man who summited Everest for a charity dedicated to individuals with special needs. There is a certain level of maturity and respect that is needed when talking to someone who not only is much more accomplished than me and who is about to spend a couple thousand dollars on a device that is going to become an integral part of their life. My training taught me how to connect with these customers and figure out what they wanted out of their Apple device and how to match them with the correct one. Additionally, not every experience at the Apple store is positive. A lot of customers get frustrated when they have to wait in line for a sales person and also when their devices don’t work properly. I had a few experiences that truly tested my patience as an 18 year old but I am proud to say that I never lost my cool. My proudest moment was when I was able to successfully clear a list of 27 customers waiting to talk to a salesperson. During my undergraduate years, my professional development took a backseat to my personal development. I spent most of my time in the books, learning how to keep house and live on my own. Throughout medical school I was able to jump start my professional development again. A lot of that came through seeing patients on my own, navigating difficult situations with patients and keeping a mental bank of all the times that I was impressed by an attending’s level of professionalism or lack thereof. I feel that going forward, having a list of “what not to do” is equally as important as a list of actions to emulate. Patients can present challenges to the medical team and its our job to stay calm and figure out why a patient is acting a certain way. On my family medicine rotation, a patient sought care for a sinus infection but when asked about a colonoscopy, refused because she believed it was “too much testing.” As a health care provider, it is easy to get angry given all the evidence to the contrary but I had to remain level headed and try to probe the patient about their reluctance. I can only imagine the level of frustration of pediatricians when parents refused to vaccinate their children. Nevertheless, the children still need medical care. With regards to an attending’s professionalism to examples stand out. The first is when my IM attending would end every patient presentation with “is there anything else WE can do for this patient?” I felt this was a wonderful way of making sure that everyone on the team feels like a valued member. On the other hand, during my OB rotation at an OSH, I had to scrub a case with a private attending who was verbally abusive to the OR staff. I have learned a lot about professionalism so far in medical school and these two CPAs will speak to what I have achieved. One is the narrative from the UPRSN ring and the other is a CPA from my pediatric GI rotation. CEO 6.0

“Narrative: Zachary was a very professional student who was inquisitive and asked insightful questions. He was engaged in patient care activities and went above and beyond in the care of his patients. His presentations were excellent and demonstrated this in-depth knowledge of his patients. Zachary was a very kind and compassionate student who worked well with all members of the team. He was respectful, responsible and dependable even when on a very busy and challenging service. He was willing to learn and worked hard to improve his medical knowledge base. His surgical and procedural and management skills were solid. Zachary was professional and interacted well with his patients and all members of the team.”

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Going forward, I strive to uphold the standards of professionalism and become a well-respected member of the medical community.

Developing as a Teacher

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When I was in elementary and middle school, my mom used to tutor me in math all the time so that I would have a solid foundational understanding of the topics I was learning. I wasn’t the fastest learner and my mom would usually have to go over concepts multiple times before “it clicked.” I was always appreciative of my mom’s patience with me so when I got to high school, I tutored my friends in math and biology. I got great feedback from my friends and a number of them told me that I would make a good teacher in the future. Since then, I have always enjoyed teaching and I try my best to be as patient with the people that I tutor as my mom was with me. Furthermore, teaching and tutoring helps me realize the concepts that I understand in depth and those where I only have a surface level of understanding. During medical school, I have had two major opportunities to teach. The first was a Musculoskeletal Anatomy Project that I completed with 2 other classmates for Dr. Julie Bishop. During the summer between M1 and M2 year, Dr. Bishop wanted help with improving the MSK anatomy component since it is the most intense out of all the blocks. With the help of a graduate anatomy T.A. along with 2 other classmates (the three of us were the leaders for the orthopedic surgery interest group) created dissection videos and high resolution PDF prosection guides (with labeled and unlabeled images) of the upper limb, lower limb and entire torso. Additionally, we put together a master list of all of the anatomy structures that could be tagged in the practical and we delivered a “Tips and Tricks” presentation to the M1s on their first day of MSK. The project took us from June to October and all of us put in a lot of effort. Since I cannot publish cadaveric images, here is a page from the anatomy structure list.

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It was immensely rewarding to use the knowledge that the three of us had learned from our MSK block to put together a product that can help future M1s for many years to come. The second opportunity that I have to teach is through ultrasound. I wanted to learn ultrasound because I felt that it was a perfect combination of technology and medicine as well as a hands-on skill that had to learned and practiced. Towards the end of my M1 year and through the subsequent summer I spent a lot of time modeling for upperclass and resident level ultrasound sessions. I was learning a ton every day and towards the middle of the summer I (as a med 1.5) was able to teach some new residents how to use ultrasound. During my M2 I helped to proctor for Trinity – a course for M1s to learn cardiac, aorta and fast scans. Over the following years, I got more involved with ultrasound and my knowledge base expanded. I am now going to be proctoring at OSU’s UltraFest on 2/25 teaching medical students from the Midwest point-of-care ultrasound. Here is a picture of me from last year’s UltraFest!

 

 

Additionally, on March 27, I will be giving a national presentation at AIUM teaching medical students from the entire U.S. about the structure and function of an ultrasound interest group. In a few years, I went from knowing nothing about ultrasound to being able to give a national presentation. Peer to peer teaching has been meaningful to me and it has helped me grow as a teacher as well as thinking of ways to improve teaching strategies. CEO 5.4. Going forward, I want to continue to advocate for the teaching of point-of-care ultrasound in all levels of medical education. Additionally, since I will most likely work with medical students in the future, I will strive to create positive learning environments for them. There have been times when I experienced “the culture of medicine” and I do not feel that I need to pass it on because I was treated that way.

Initial Inertia

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When I was in undergrad, I attempted to start a club called “Buckeyes and Apples.” My goal was to create a forum for people who were passionate about their Apple products to come together and network. Given my experience working at the Apple Store, I saw how excited people were with regards to their Apple devices and I thought that I would have no trouble at all attracting people to come to my meetings. At first, I invited a number of my friends to the first meeting but no one came. I rethought my strategy and decided that direct marketing was the correct approach. Before the second meeting, I spent a few days walking around campus and giving out fliers to people who were using Apple products. Unfortunately, the second meeting came and went without anyone in attendance. I didn’t know what to do and I was essentially trying to get the club off the ground by myself. My studies were starting to take more of my time so I decided not to carry on with promoting the club. When I got to medical school, I wanted to give leadership another try. I spent the majority of M1 year adjusting to the volume and coursework and by M2 I was ready to take on extra-curriculars. I became the treasurer of the Orthopedic Surgery Interest Group as well as the Treasurer of the Ultrasound Interest Group (USIG). During my M3 year, I took on the role of president of both the Ultrasound Interest Group and the National Ultrasound Interest Group (NUSIG). Currently, I serve as advisor to the current president of USIG and remain on the executive committee of NUSIG. Here is a picture of the current USIG executive board. My leadership experiences in medical school were vastly different from the one that I had trying to run Buckeyes and Apples. During my 3 years on the executive board for USIG, I saw what it takes to successfully run an organization. With Buckeyes and Apples, I was a one man band with minimal support trying to get a movement off the ground. With USIG, there are two wonderfully dedicated faculty advisors: Dr. Boulger and Dr. Bahner as well as a small army of medical students who are passionate about point-of-care ultrasound. Drs. Boulger and Bahner provide support and resources and the executive team can break down projects into smaller “accomplishable” pieces. I realized that it takes a lot of inertia as well as like-minded people to get an idea off the ground. Here is a picture of the current USIG exec team.

 

Through my leadership experiences I also developed my own leadership style. One of the most important aspects of teamwork is to make sure that everyone on the team feels valued and that they are making meaningful contributions. In order to accomplish that, I bring up projects that need to be accomplished but encourage the other members of my team to come up with ideas and implement them. That way, I am guiding the team to help accomplish its vision together rather than telling everyone what they need to do. As a future anesthesiologist, I will be the leader of the OR team and learning these leadership skills has been extremely important to me. My narrative from my sub-I is a nice representative of my teamwork skills. CEO 4.1

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As a future anesthesiologist, patient safety will be my number one concern. Going forward, my goals are to create a team environment where everyone is valued and feels safe speaking up on the patient’s behalf. Additionally, I want to do a more effective job at getting an idea, initiative or club off of the ground.

Tennis and Latin Dancing

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Before coming into medical school people jokingly told me that I’m going to have to study for the rest of my life. I didn’t really understand what that statement meant until about a week into My M1 year when I realize just how much information I would have to take it on regular basis. What’s interesting is that I don’t remember exactly when but I reached a point in medical school where I realized that there is something that I should always be doing or studying or reading. I came to the conclusion that I was going to have “homework” for the rest of my life whether I liked it or not. However, it is easy to get wrapped up in the volume of information that is needed to successfully pass medical school. I needed balance in my life in order to cope with the stresses of medical school. I grew up playing tennis since I was 10 years old and my tennis career peaked when I was on the varsity team during my junior year of high school. It didn’t take me long to understand that my shot at Wimbledon was never going to come so I just transitioned my tennis game to more of a recreational one. Tennis is a lot of fun – it’s a noncontact sport where you can get a great cardio workout while you’re at it. During my undergrad years I would always play tennis during the summers on the courts right by RPAC and I continued that into medical school. I would either play with my friends or whomever I could find on the courts. The extracurricular activity that I am most proud of though is my dancing. I started out ballroom dancing in undergrad and transitioned from ballroom to Latin social dancing specifically salsa merengue and bachata. It doesn’t seem likely that a small nerdy Russian Jewish kid would get involved in Latin dancing but it has turned into a passion of mine. Surprisingly Columbus has a large salsa dancing scene and I have been dancing almost once a week for the past six years. I absolutely love going to dance and it’s amazing to see how many interesting in educated people I can meet while dancing. I have danced with attendings, residents lawyers, people with PhD’s and others. Dancing has been a way where I can completely let go of my stress. If I have a difficult week in the hospital I know that I can go dancing either Friday or Saturday night and I can completely dance the week away and start fresh. During my month for studying for step two CK I even found a practice partner and in a period of a month I practiced with her for almost 2 hours every day and I was able to elevate my dancing skills. All in all, tennis and dancing have brought me the balance that I needed to successfully get through medical school thus far. Here’s a picture of me dancing.

 

What was extremely helpful was that I had both of these hobbies developed prior to entering medical school which shows the importance of having a routine. When I was stressed and needed relief, I had skills that I can rely on and I was able to quickly destress myself without having to develop new hobbies or interests. One of my goals in residency is to make sure that I am making time for myself because that keeps me grounded as a person. I want to make sure that I continue to play tennis when the weather permits and I want to make sure that I go dancing as often as I possibly can. CEO 3.4b.

My time in medical school has also taught me the meaning of “life-long learning.” Life-long learning can be both retrospective and prospective. The retrospective aspect comes through reading and literature review while the prospective component is fulfilled with answering clinical questions. I learned about evidenced based medicine and how applying it can greatly help patient care. Through the CAT project of AMRCC, I learned how to think through and synthesize the evidence available to me. CEO 3.2. Here is my CAT project.

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For the prospective component, my group’s HSIQ project is about using correct tidal volumes for patients during surgery. It is established that a safe tidal volume is about 6-8cc/kg when someone is on a ventilator. My group is looking at a random sample of GI surgery cases to see how many anesthesiologists used a safe tidal volume and if our intervention can increase that number CEO 3.1. My goals during residency and for my career are to always remain inquisitive and make sure that I stay up to date with current literature.

The Nerd that Found Ultrasound

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Before coming into medical school, I had a limited base of medical knowledge. As an undergrad, I majored in molecular genetics so I understood the basis of a few human diseases that are caused by genetic mutations but that’s all I knew. My biggest surprise in the first weeks of medical school was the volume of information that I had to consume and process. I remember listening to a genetics lecture and thinking to myself, “what the professor just covered in 60 slides was an entire semester course for me in undergrad!” Nevertheless, I rose to the challenge of processing the large volume of information by adapting study strategies that I had solidified in undergrad. I grew to love thinking through physiology and my interest grew with each new block. I even started to question my initial choice of surgery because I realized that surgery would not provide me with many challenging physiological problems. Overall, I am proud to say that I did well during my first two years – I received honors or letters in most body unit blocks and finished with a letter overall. I studied hard for step 1 and received a 238. I was moderately happy with my score but I felt that it didn’t reflect my capabilities and my previous academic record in undergrad and high school. Throughout third year I did not perform well on my shelf exams. It seemed that no matter how hard I studied or what resources I used, I never did well on any of them. Because of this, I was nervous for Step 2 but I was elated when I received a 257.  I finally felt that my score reflected my academic potential. CEO 2.1

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One of my proudest accomplishments during medical school was learning ultrasound. I always had a technology theme to my life when I was growing up so I was excited to have an opportunity to learn a skill that combines medicine with technology. Dr. Boulger and Dr. Bahner had contagious enthusiasm for medical student involvement so I jumped on board. By the beginning of M2 year, I could do basic TTE, FAST exams and aorta scans. I always loved to work with my hands so I really enjoyed scanning my classmates. The experience was so much fun – we learned a skill, physiology and anatomy all at the same time. I also started to proctor ultrasound events and helped teach other medical students and some residents. Additionally, I got involved in the leadership of the Ultrasound Interest Group and the National Ultrasound Interest Group. I hope to continue learning as much ultrasound as I can. CEO 2.4

 

 

With regards to medical knowledge and skills, I have two main goals during residency. The first is that during intern year, I want to build a solid IM foundation because that will help me understand the pathophysiology of disease states that patients will have while undergoing surgery. The second goal that I have for myself is to read and learn as much as I can to become the best anesthesiologist that I can be.

From High School Volunteering to Third Year Rotations

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I was introduced to patient care during junior year of high school when I volunteered at my local hospital. I worked on a med/surg unit every Monday evening checking-in on patients and answering call lights. My experience helped me learn to communicate with patients which set me up well for medical school. When I got to medical school, I was placed in a General Surgery Clinic at OSU East for longitudinal practice. I was excited to see patients but now I had to process their clinical situation. I have seen a lot of growth in myself over the past few years. In LP, we would receive yellow cards with objectives relating to the body unit we were covering at that time. For example, some of the objects would be take a history and perform a neuro exam for the neuro block or perform an abdominal exam for GI. As evidenced by the monitor comments for my first OSCE, I had a lot of room for improvement!

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With each passing year, my skills increased and by M4 year I did my sub-I in the CVICU where I had to run through every body system during the patient presentation! Looking at my CPAs from my pediatric pulm elective and my sub-I, I have certainly come a long way.

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Additionally, my experience with ultrasound has helped me think about a patient’s complete clinical picture. I was on a scanning shift and it was thought that a patient has acute cholecystitis. The scanning team came in and asked the patient about their symptoms which they reported to be abdominal pain, pelvic pain and right leg pain that weren’t associated with eating. Upon scanning, we found numerous gallstones but there were no other sonographic signs of cholecystitis and the patient’s WBC and LFTs were normal. This experience helped show me that I can’t focus in on one finding or lab result and that for optimal patient care, the whole clinical picture needs to be taken into account. CEO 1.2.

Thinking ahead to residency, my goals for patient care are two fold. My first goal is to learn to give clear, concise and effective patient handoffs. This will benefit my future patients by minimizing mistakes and making sure that there is follow-up for any leftover actionable items. My second goal is to try and take a few extra minutes thinking about the patient’s diagnosis and lab results to make sure that the entire clinical picture fits. It is easy to overlook other factors once a preliminary diagnosis has been established.